Saturday, October 12, 2013

What are Ketones....

and why do us Type 1 Parents (T1Ps) freak out about them?

If you've ever read my blog or Facebook page, you might have noticed that I am less than happy when I find out that one of my girls is spilling ketones. And chances are, unless you're a T1P yourself, you probably have no clue what I'm talking about.

Never fear, today I'm going to fill you in.

What Are Ketones???

When a body is unable to burn glucose it burns fat and this produces a chemical called ketones. Ketones are generally produced when too little insulin is produced for the amount of glucose in the body. So your body burns fat to create energy instead, thus producing the acid ketones.

Why is This Bad?

Burning fat sounds awesome right??? Well in a diabetic it can lead to Diabetic Ketoacidois (DKA) and that is one of the two big emergencies that type 1 diabetics face. (The other is hypoglycemia, or low blood sugar.)

DKA occurs when ketones build up due to a lack of insulin. The ketones will start spilling into the
urine and if the body still doesn't get enough insulin that it needs then it can lead to a diabetic coma or death.

What are the Symptoms of DKA?

*Usually high blood sugars.

Usually. Kayleigh is more prone to spill ketones than Mackenzie and her blood sugar is usually within a normal (for her) range when this happens.

That's diabetes for you. It's never predictable. You can certainly make educated and informed decisions regarding D-Care but you have to be prepared to be wrong. Because diabetes does not care about the "rules". It can be something different every single day and for every single person with diabetes.

*Extreme thirst and frequent urination.

Caused, of course, by the high blood sugars.

*Higher Levels of Ketones in the Urine.

You can check this using a urine test or blood test. The blood test is more accurate because it's up-to-date information. The urine test is a couple of hours behind. Usually if the ketones are 1 mmol/L or less it's pretty easy to treat by pushing water and upping their insulin a bit. But it's a balancing because if they're blood sugars are within range or low you cannot safely give more insulin because you'll drop them low and that's a different kind of diabetes scare.

My girls have also complained of blurry vision and headaches. Usually the time you hit this symptoms your ketone levels are moderate, somewhere between 1 & 3 mmol/L.

Treatment here definitely requires a big insulin push. If they're blood sugar is high enough, that is. If not you can try to give them food or drink to raise their sugar so you can give them the insulin.

Once you hit the 3 mmol/L mark you spilling high ketones, and this is when you might see...

*Labored breathing

*Extreme weakness/exhaustion*Eventually unconsciousness.

Now you've reached DKA territory and it's mostly likely time to get them to the doctor for treatment.

Ketones in our World

I've, unfortunately, experienced my fair share of ketones. Both girls tend to develop them when they're not feeling well. It's not uncommon for ketones to develop when there's illness involved.

Mackenzie's ketones were 2.6 at diagnosis. Her extreme weight loss in the months prior were a big clue to that. She's so fortunate that she wasn't DKA with as long as she went undiagnosed. God was watching over her.
Kayleigh tends to spill them quite easily and she does it with her blood sugar in range which makes
treating them very difficult. She's had many random and unexplained periods where she vomits for 24 hours and her ketones shoot up. She never has any other symptoms of illness, just the vomiting, and perfect blood sugars. You can imagine that treating the ketones with insulin is next impossible when you can't give her food to raise her glucose because she can't hold anything down.

So far the trick has been to get her to sleep and get her to drink some juice while she's sleeping or suck on a lollipop. Eventually the blood sugar goes up enough where I can give insulin and that seems to knock the ketones down quite quickly.

Still, she gave us quite a scare once with 3.3 ketones. Thankfully I was able to give her insulin at the point and they dropped quickly. We were packing up her bag to take her to the hospital so she got lucky.

Type 1 Awareness

You might have noticed that a lot of the symptoms of DKA are also the symptoms that you might have type 1 diabetes. That's because a lot of the time people are near, if not in, DKA when they are diagnosed. Why?

Because there is not remotely enough awareness about type 1 diabetes out there. More people die from complications from diabetes (type 1 and 2) than from breast cancer and aids combined but still nobody is aware of the symptoms.

I go to my annual physical and get a breast examine every single time. But never once did our pediatrician check my girls for diabetes. Even though Mackenzie had the symptoms for over a year. It didn't even occur to the doctor to check because, even in the medical field, there isn't enough awareness about type 1 diabetes. A simple, in-office, finger prick at every child's physical could go a long way to saving a child's life.

Next month is American Diabetes Month and, until my girls were diagnosed, I'd never heard anything about it. Even now, I only hear about it from other people affected by diabetes. It is my my prayer that this is the year that I see 1/3 of the amount of diabetes ribbons as I do for cancer. Just 1/3 of the amount would go a long way to saving a lot of lives. Once day I hope to see just as many because the awareness is desperately need.